Adrienne W. Email & Phone Number

Appleton, Wisconsin, United States

• Responsible for supporting our Account Management team in resolving Medicare Part D-specific client issues.
• Responsible for EGWP operational performance management.
• Provides support for annual plan submission of our EGWP plans to the Centers for Medicare & Medicaid Services (CMS), including proficiency in using CMS plan benefit package software.
• Responsible for creating and maintaining Medicare benefit specification documents for all EGWP client implementations and re-implementations.
• Develops and maintains templates, including Spanish-translated versions, for the annual Medicare Part D Prescription Drug Plan Employer Group Waiver Plan (EGWP) beneficiary materials. Using these templates, the SPM is.
• Provides oversight for managing translations and web posting of annual Medicare Member materials.

• Assisted in Medicare plan finder file creation, quality assurance and data submission following the Centers for Medicare and Medicaid Services regulated schedule. Performed initiatives to improve Star Ratings in the.
• Implemented UnitedHealthcare’s Medicare Part D contracts plan finder functionality to be accessible on www.medicare.gov.
• Resolved CMS outliers to prevent plan finder suppression.
• Created and analyzed Price Accuracy Index reports to forecast and improve Star Ratings in the Medicare marketplace.
• Led automation projects that improved business processes.

• Researched, gathered, analyzed complex operational and customer data in order to identify trends, create forecasts and present multifaceted information to executive decision makers. Instrumental in providing data for.
• Pinpointed redundancies and non-performing areas in order to create strategic plans to deliver positive outcomes in a demanding setting.
• Created job material and a SharePoint site to educate cross-functional leadership teams that provided the foundation to identify opportunities and boost client participation.
• Served as client account liaison for Employer Group Waiver Plan contract, researched contract requirements, anticipated issues and integrated solutions to achieve quality standard measurements.
• Led an online forum with over 100 participants.

Tulsa, Oklahoma Area

• Coordinates quality review of pharmacy processes, and makes recommendations for corrective actions
• Act as a Liaison between GlobalHealth pharmacy staff and PBMs, and provides project management and oversight for interactions with PBM
• Prepares and supports the submission of regulatory agency applications, reports, or correspondence related to the pharmacy benefit.
• Reviews all regulatory agency submission materials related to the administration of the pharmacy benefit to ensure timeliness, accuracy, comprehensiveness, or compliance with regulatory standards.
• Provides regulatory guidance to departments or development projects regarding design, development, evaluation, or marketing of plan related to the pharmacy benefit.
• Formulates & implements regulatory affairs policies and procedures to ensure that regulatory compliance is maintained or enhanced in relation to the pharmacy benefit.

Tulsa, Oklahoma Area

• Provides reporting and data analysis to the pharmacy department and plan senior executive.
• Presents actionable data and analysis to support senior executive staff decisions on benefit design, utilization management, and government reporting requirements.
• Supports many internal plan committees by providing data and analysis for review and oversight by committee members.
• Develops, updates, and maintains the department’s commercial prior authorization forms and prescription claims databases for all lines of business, UM departments, HRA, and Member Outreach.

• Responsible for the due diligence of the collection of problem loans and relationships, and provides support to the Special Assets team with the goal of reducing losses and maximizing recoveries.
• Ensures collateral position through independent research respective to UCC filings, title searches, insurance verification, etc.; and uses judgment to determine appropriate course of action to solve for any.
• Responsible for identifying collateral and beginning applicable processes to protect collateral to prevent future loss
• Analyzes loan agreements to find possible solutions embedded in the documents then uses judgement to determine appropriate course of action for any deficiencies in findings
• Works with customers, vendors, department staff and bank management regarding inquires on transactions, account status and operations. Responsible for accurate resolutions of routine account problems.

• Perform a wide range of banking operations requiring a broad knowledge of banking practices, regulatory requirements and daily procedures essential to retaining and expanding relationships with financial customers and.
• Balance ACH, Wire Transfer, non-posts, charge backs and special items in order to balance transactions with the Federal Reserve
• Process investment transactions with Dreyfus and Fidelity
• Process Tax Garnishments, IRS/State/Court Levies in accordance with banking polices and laws
• Monitor accounts for Identity Theft, OFAC, & Red Flags; confirm accuracy of transactions
• Consistently meet/exceed expectations; recognized for outstanding service abilities

Bachelor Of Science In Business Administration, Pharmaceutical Marketing And Healthcare Management

Graduated with a Bachelor of Science in Business Administration of Sciences .The focus of the degree was in Health Care Administration.

Bachelor Of Business Administration (B.B.A.), Nursing Concentration

Entrepreneurship/Entrepreneurial Studies

The Oklahoma State University Cowboy Bootcamp for Entrepreneurs was a hands-on learning experience for eager minds wanting to start.